Nager A, Sundquist K, Ramírez-León V, Johansson L M
Karolinska Institute, Center for Family Medicine, Stockholm, Sweden.
Acta Psychiatr Scand. 2008 Jan;117(1):12-9. doi: 10.1111/j.1600-0447.2007.01096.x. Epub 2007 Oct 12.
The severity of postpartum psychosis calls for further research on the association between obstetric variables and this psychiatric disorder.
A total of 1,133368 Swedish first-time mothers were included during a 29-year period yielding 1413 hospitalized cases of postpartum psychosis. Several obstetric variables were analysed separately after adjustment for possible confounders.
Respiratory disorder in the neonate, severe birth asphyxia, preterm birth, caesarean section, perinatal death and SGA infant were associated with an increased risk of postpartum psychosis. After adjustment for previous hospitalization for psychiatric disorder only preterm birth and acute caesarean section remained significant risk factors for postpartum psychosis (relative risks were 1.20 and 1.31 respectively). The relative risk of postpartum psychosis among first-time mothers with previous hospitalization for psychiatric disorder was increased more than 100-fold.
Careful clinical risk assessments of postpartum psychosis are crucial among women with a history of psychiatric disorder whereas obstetric variables have a minor importance.
产后精神病的严重性需要对产科变量与这种精神障碍之间的关联进行进一步研究。
在29年期间纳入了总共1133368名瑞典初产妇，产生了1413例产后精神病住院病例。在对可能的混杂因素进行调整后，分别分析了几个产科变量。
新生儿呼吸系统疾病、严重出生窒息、早产、剖宫产、围产期死亡和小于胎龄儿与产后精神病风险增加相关。在对既往精神疾病住院史进行调整后，只有早产和急诊剖宫产仍然是产后精神病的重要危险因素（相对风险分别为1.20和1.31）。既往有精神疾病住院史的初产妇产后精神病的相对风险增加了100多倍。
对于有精神疾病史的女性，产后精神病的仔细临床风险评估至关重要，而产科变量的重要性较小。
